Factores asociados a infección de vías urinarias luego de una prostatectomía

Resumen

Introducción y Objetivo La cirugía de próstata es un procedimiento frecuente en varones mayores. Existen diferentes técnicas, cuya elección depende de la patología a tratar, de la experiencia del especialista, y de la disponibilidad técnica. Entre sus complicaciones se encuentra la infección del tracto urinario, que ocasiona incremento en morbimortalidad y costos para el sistema de salud. El objetivo principal de este estudio fue evaluar los factores relacionados con la aparición de infección urinaria luego de este tipo de cirugía.

Materiales y Métodos Se realizó un estudio de casos y controles en una población de pacientes sometidos a prostatectomía del 2018 hasta principios del 2020 en Medellín, Colombia. Los casos correspondieron a los pacientes que presentaron infección de vías urinarias hasta 30 días tras la prostatectomía. Se estimó la asociación entre casos y controles por medio del cálculo de la razón de disparidad (RD), la cual se ajustó con una regresión logística y con un modelo aditivo generalizado multivariado.

Resultados Se identificaron 96 casos incidentes de infección del trato urinario luego de la prostatectomía, con una prevalencia de 8.99%. La frecuencia de solicitud de urocultivo preoperatorio fue de 52,92% (intervalo de confianza del 95% [IC95%]: 48,34–57,44%). Las variables independientemente asociadas con la aparición de infección urinaria fueron: solicitud de urocultivo prequirúrgico, número de dosis, y tipo de antibiótico usado para la profilaxis. Particularmente, se encontró como factor protector el uso de aminoglucósidos. En los pacientes con infección urinaria, los principales gérmenes aislados fueron: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis y Serratia marcescens.

Conclusión Este estudio demuestra que factores como la solicitud preoperatoria de urocultivo y el uso de aminoglucósidos en los esquemas de profilaxis quirúrgica reducen la probabilidad de desarrollar una infección urinaria luego de una prostatectomía.

Abstract

Introduction and Objective Prostate surgery is a common procedure among older men. There are different techniques, and the choice depends on the pathology to be treated, the experience of the specialist, and the technical availability. Among its complications is urinary tract infection, which causes increased morbidity and mortality and costs for the health system. The main objective of the present study was to evaluate the factors related to the onset of urinary tract infection after prostate surgery.

Materials and Methods A case-control study was conducted in a population of patients undergoing prostatectomy from 2018 to early 2020 in the city of Medellín, Colombia. The cases corresponded to patients who presented urinary tract infection up to 30 days after prostatectomy. The association between cases and controls was estimated by calculating the odds ratio (OR), which was adjusted with logistic regression and a multivariate generalized additive model.

Results We identified 96 incident cases of urinary tract infection after prostatectomy, with a prevalence of 8.99%. The frequency of requests for preoperative urine culture was of 52.92% (95% confidence interval [95%CI]: 48.34 - 57.44). The independently associated variables were: request for preoperative urine culture, number of doses, and type of antibiotic used for prophylaxis. In particular, the use of aminoglycosides in prophylaxis schemes was found to be a protective factor. The main germs isolated were: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis, and Serratia marcescens.

Conclusion The present study shows that factors such as the preoperative request for urine culture and the use of aminoglycosides for surgical prophylaxis influence the probability of developing urinary tract infection after prostatectomy.

Palabras Clave

bacteriuria - infecciones del tracto urinario - prostatectomía - resección transuretral de la próstata - complicaciones posoperatorias - factores de riesgo

Keywords

bacteriuria - urinary tract infections - prostatectomy - transurethral resection of the prostate - postoperative complications - risk factors

Publication History

Received: 29 April 2021

Accepted: 23 August 2021

Article published online:
31 March 2022

• Referencias

• 1 Caro-Zapata FL, Vásquez-Franco A, Correa-Galeano EDG-VJ. et al. Complicaciones infecciosas después de prostatectomía abierta y resección transuretral de próstata en pacientes con hiperplasia prostática benigna. Iatreia. 2018; 31 (03) 274-283
• 2 Khalil MI, Bhandari NR, Payakachat N, Davis R, Raheem OA, Kamel MH. Perioperative mortality and morbidity of outpatient versus inpatient robot-assisted radical prostatectomy: A propensity matched analysis. Urol Oncol 2020; 38 (01) 3.e1-3.e6 DOI: 10.1016/j.urolonc.2019.07.008.
• 3 Pérez Manzanares VM, Salinas González F, García Vásquez RA, Arriaga Aguilar J, Candia Plata MC. Estudio comparativo de adenomectomía prostática laparoscópica y abierta. ¿Cuál ofrece mejores resultados?. Rev Mex Urol 2016; 76 (02) 99-103 DOI: 10.1016/j.uromx.2016.01.007.
• 4 Mohee AR, Gascoyne-Binzi D, West R, Bhattarai S, Eardley I, Sandoe JAT. Bacteraemia during transurethral resection of the prostate: What are the risk factors and is it more common than we think?. PLoS One 2016; 11 (07) e0157864
• 5 Hwang EC, Jung Il SI, Kwon DD. et al. A prospective Korean multicenter study for infectious complications in patients undergoing prostate surgery: risk factors and efficacy of antibiotic prophylaxis. J Korean Med Sci 2014; 29 (09) 1271-1277
• 6 Colau A, Lucet JC, Rufat P, Botto H, Benoit G, Jardin A. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. Eur Urol 2001; 39 (03) 272-276
• 7 Cruz Arévalo A, Cárdenas AM, Gómez JE, Reyes JC, Duarte RA. Factores predictores de complicaciones infecciosas en pacientes sometidos a prostatectomía. Urol Colomb [Internet] 2016; 26 (02) 81-86 DOI: 10.1016/j.uroco.2016.06.003.
• 8 Gupta K, Hooton TM, Naber KG. et al; Infectious Diseases Society of America, European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52 (05) e103-e120
• 9 Ministerio de salud y protección social. [Internet]. [cited 2021 May 25]. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
• 10 de Cueto M. [Microbiological diagnosis of urinary tract infections]. Enferm Infecc Microbiol Clin 2005; 23 (Suppl. 04) 9-14
• 11 Köves B, Tenke P, Tandogdu Z. et al. Transurethral Resection of the Prostate: are We Following the Guidelines? - Outcomes from the Global Prevalence of Infections in Urology (GPIU) Study. J Chemother 2019; 31 (01) 15-22 DOI: 10.1080/1120009X.2018.1542552.
• 12 Li Y-H, Li G-Q, Guo S-M, Che Y-N, Wang X, Cheng F-T. Clinical analysis of urinary tract infection in patients undergoing transurethral resection of the prostate. Eur Rev Med Pharmacol Sci 2017; 21 (20) 4487-4492 http://www.ncbi.nlm.nih.gov/pubmed/29131269
• 13 Nicolle LE, Gupta K, Bradley SF. , et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Vol. 68, Clinical Infectious Diseases. Oxford University Press; 2019:E83–E75.
• 14 Grabe M, Bartoletti R, Bjerklund-Johansen TE. , et al. Guidelines on Urological Infections. Eur Assoc Urol [Internet]. 2015;33–40. Available from: http://www.uroweb.org/gls/pdf/15_Urological_Infections.pdf
• 15 Cai T, Verze P, Palmieri A. et al. Is Preoperative Assessment and Treatment of Asymptomatic Bacteriuria Necessary for Reducing the Risk of Postoperative Symptomatic Urinary Tract Infections After Urologic Surgical Procedures?. Urology 2017; 99: 100-105 https://pubmed.ncbi.nlm.nih.gov/27773650/ cited2021Apr16 [Internet]
• 16 Gallegos Salazar J, O'Brien W, Strymish JM, Itani K, Branch-Elliman W, Gupta K. . Association of Screening and Treatment for Preoperative Asymptomatic Bacteriuria with Postoperative Outcomes among US Veterans. In: JAMA Surgery. American Medical Association; 2019. p. 241–8.
• 17 Lightner DJ, Wymer K, Sanchez J, Kavoussi L. . Best Practice Statement on Urologic Procedures and Antimicrobial Prophylaxis. [cited 2021 Apr 17]; Available from: https://doi.org/10.1097/JU.0000000000000509
• 18 Machado-Alba JE, González-Santos DM. . Dispensación de antibióticos de uso ambulatorio en una población colombiana. Vol. 11, Revista de Salud Pública. scieloco; 2009. p. 734–44.
• 19 Erdem H, Kiliç S, Pahsa A, Besirbellioglu BA. Gram-negative bacterial resistance to cephalosporins in community-acquired infections in Turkey. J Chemother 2005; 17 (01) 61-65 DOI: 10.1179/joc.2005.17.1.61.
• 20 Hayward RS, Harding J, Molloy R. et al. Adverse effects of a single dose of gentamicin in adults: a systematic review. Br J Clin Pharmacol 2018; 84 (02) 223-238 http://doi.wiley.com/10.1111/bcp.13439 cited2021Apr17 [Internet]
• 21 Nielsen DV, Fedosova M, Hjortdal V, Jakobsen C-J. Is single-dose prophylactic gentamicin associated with acute kidney injury in patients undergoing cardiac surgery? A matched-pair analysis. J Thorac Cardiovasc Surg 2014; 148 (04) 1634-1639 DOI: 10.1016/j.jtcvs.2014.05.090.
• 22 Schober P, Vetter TR. Logistic Regression in Medical Research. Anesth Analg 2021; 132 (02) 365-366 https://journals.lww.com/anesthesia-analgesia/Fulltext/2021/02000/Logistic_Regression_in_Medical_Research.12.aspx